The Serbian people are resilient. Tumultuous Serbian centuries have seen empires rise and fall. in the past three decades alone, Serbs have weathered political upheaval and civil war, all topped off by a two and a half month long airstrike. But today, they face an unprecedented problem: cancer. In the text below is the list of five key facts about cancer in Serbia.

5 Facts About Cancer in Serbia

Serbia has the highest cancer mortality rate in Europe. Systematic reporting of the incidence and mortality caused by cancer in Serbia did not begin until the 1990s. The first nationwide, population-based study done from 1999 to 2009 showed that cancer mortality in Serbia was steadily increasing. However, as of 2009, the mortality rate caused by cancer in Serbia has been decreasing by approximately 0.9 percent annually. Regardless, Serbia still has the highest cancer mortality rate in Europe and the fourth highest rate in the world.

Some blame uranium for this problem. The President of the Serbian Society for the Fight against Cancer, Slobodan Cikaric, claims that NATO’s airstrikes on Serbia in 1999 are responsible for the high mortality rates since 15 tons of depleted uranium were dropped on Serbia. Studies have shown that depleted uranium is a carcinogen: when ingested, it interrupts the normal cell growth process and can lead to malignant tumors. In response to this allegation, NATO referenced the UN Environment Program report. The report released in 2001 holds that health risks from uranium are negligible.

Cancer risk factors are prevalent in Serbian society. When it comes to pinpointing cancer risk factors in Serbia, the lack of adequate health care is only the tip of the iceberg. There are few comprehensive cancer detection initiatives, and delayed diagnosis is often associated with a higher likelihood of mortality. An underfunded health care system means that the appropriate technology to treat certain cancers is often unavailable. There are many other variables to consider. Drinking and smoking are common, and daily physical activity is not. Nearly half of all Serbian men smoke, however, the Government of Serbia has made strides in tobacco control, from issuing television advertising bans to enforcing smoke-free zones at schools.

The crisis differs by groups. Mortality from major cancers is higher in men. Lung cancer is the most common cancer in Serbian men, while breast cancer is the most common cancer in Serbian women. In fact, as of 2008, the breast cancer incidence and mortality rate in Serbian women was the highest in Europe. The incidence of cervical cancer is also alarmingly high: one and a half women die from cervical cancer every day in Serbia.

Serbs are taking strides to improve health care outcomes. Marija Ratkovic, a Belgrade journalist, has been open about her fight against cervical cancer. Through a VICE documentary, she spreads awareness for the disease and shows women that they are not alone. With her platform as a popular news columnist, Ratkovic encourages women to be vaccinated and regularly screened. In 2016, the vaccine to protect from HPV, the virus that often leads to cervical cancer, became available in Serbia. In 2014, the World Bank secured $40 million for the Second Serbia Health Project, an evidence-based initiative designed to make the Serbian health care system more efficient. It reduced the cost of drugs and allowed public hospitals to purchase more equipment. In 2014 alone, it reduced the total cost of drugs throughout Serbia by €25 million.

Ultimately, to alleviate the crisis of cancer diseases in Serbia, the focus must be on addressing the multitude of risk factors and improving the productivity of the health care system. The Serbian government, with the help of focused foreign aid initiatives, has the power to save lives.